Clinical Application Of Intramedullary Telescope Nail In Treatment Of Children With Refractory Pathological Fracture

Objective: To evaluate the feasibility,therapeutic effect of intramedullary telescope nail in treatment of children with refractory pathological fracture,and to evaluate the complications for prevention and remedy.Method: From May 2017 to October 2018,14 children with refractory pathological fracture due were treated with intramedullary telescope nail,14 femurs were included.There were 7 males and 7 females,aged from 5 years and 11 months to 16 years and 4 months.In the 14 cases,10 cases were of osteogenesis imperfect,according to Sillence classification,there were 3 cases of type III and 7 cases of type IV.4 cases were of fibrous dysplasia,1 case was single type,3 cases were poly type.All children were operated by multiple corrective osteotomy and be fixed by intramedullary telescope nail,4 cases of fibrous dysplasia were combined with focal clearance.Result: All the 14 cases were followed up for 6-22 months,with an average of 13 months.The bones healing time was 8-12 weeks(average,10 weeks).According to Sanders grading standard,8 cases were excellent,5 cases were good,1 case was poor.The mean Barthel index score were improved from 72.85±16.65 to 90.71±9.58.Compared with before,intramedullary telescope nail were prolonged by 13.83 mm on average.The motion ability and daily activity of function of most children were improved after operation.There were 2 cases does not be prolonged,2 cases had migration of nail.1 case developed into nonunion.Conclusion: Intramedullary telescope nail fixation can be extended due to patient growth.The occurrence of re-fracture after operation would be avoided effectively.What's more,the motion ability and daily activity of function would be improved significantly.Anyway,Intramedullary telescope nail fixation is effective for the treatment of refractory pathological fracture in children.The complications should be prevented and dealt with actively.